Use of Spectral-Domain Optical Coherence Tomography to Analyze Macular Thickness According to Refractive Error

Seung Hoon Kim; Joo Youn Park; Tae Kwann Park; Young-Hoon Ohn

doi:10.3341/jkos.2011.52.11.1286

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Kim, Park, Park, and Ohn: Use of Spectral-Domain Optical Coherence Tomography to Analyze Macular Thickness According to Refractive Error

Original Article

J Korean Ophthalmol Soc 2011;52(11):1286-1295.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.11.1286

Use of Spectral-Domain Optical Coherence Tomography to Analyze Macular Thickness According to Refractive Error

Seung Hoon Kim, MD, Joo Youn Park, MD, Tae Kwann Park, MD, PhD, Young-Hoon Ohn, MD, PhD

Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Address reprint requests to Young-Hoon Ohn, MD, PhD Department of Ophthalmology, Soonchunhyang University Bucheon Hospital #1174 Jung-dong, Wonmi-gu, Bucheon 420-767, Korea Tel: 82-32-621-5053, Fax: 82-32-621-5435, E-mail: yhohn@schmc.ac.kr

Received 23 December 2010 Revised 13 April 2011 Accepted 30 August 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the correlation of macular retinal thickness and refractive error using spectral-domain optical coherence tomography (SD-OCT).

Methods

A total of 120 eyes with no posterior abnormalities were enrolled in the present study. Subjects were divided into 3 groups based on their spherical equivalent. Visual acuity, refraction, slit lamp examination, tonometry and fundus examination were performed. Retinal thickness between the RPE and IS/OS junction was measured at the fovea, 1 mm (inner ring) and 2 mm (outer ring) superiorly, inferiorly, nasally and temporally using SD-OCT. Overall average thickness, average foveal thickness, and the inner and outer ring macular thickness were measured.

Results

The average foveal thickness was significantly greater in the high myopic eyes than in the low to moderate myopic and emmetropic eyes (p = 0.001). However, the RPE-IS/OS junction thickness of the foveola and the outer macular thickness were significantly lower (p = 0.001, p = 0.002) in the high myopic eyes. There was a weak, but significant negative correlation between refractive error and average foveal thickness (r = −0.38, p = 0.001). A positive correlation was found between refractive error and the RPE-IS/OS junction thickness (r = 0.40, p = 0.001).

Conclusions

Macular retinal thickness is related to refractive error in normal subjects. Effects of eyeball elongation are more apparent in high myopic eyes than in low to moderate myopic eyes. A significant decline in the RPE-IS/OS junction thickness suggests the photoreceptor outer segments in the foveola are damaged in high myopic eyes.

Keywords: Macula, Macular thickness, Myopia, Refractive error, Spectral-domain optical coherence tomography

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Figure 1.

Intraretinal measurements in Cirrus HD-OCT. Retinal thickness between RPE and IS/OS junction was measured at the fovea, 1.0 mm superiorly, 1.0 mm inferiorly, 1.0 mm nasally, 1.0 mm temporally, 2.0 mm superiorly, 2.0 mm inferiorly, 2.0 mm nasally and 2.0 mm temporally (Blue bar in figure 1A), by manually using the scale supplied with the software (Black arrow in figure 1B). Note that measurements in 1.0 mm superiorly, inferiorly, nasally and temporally represent inner circle and measurements in 2.0 mm superiorly, inferiorly, nasally and temporally represent outer circle, similarly.

Figure 2.

ETDRS subfields within standard 1, 3 and 6 mm diameter concentric circles on the right used for reporting retinal thickness. F = fovea; SI = superior Inner; NI = nasal inner; II = inferior inner; TI = temporal inner; SO = superior outer; NO = nasal outer; IO = inferior outer; TO = temporal outer.

Figure 3.

Scatterplots show the relationship between spherical equivalent and macular measurements. As myopia became more severe, average foveal thickness (B) increased. In contrast, thickness between RPE-IS/OS junction (A), average outer thickness (C) and total macular volume (D) decreased as myopia became more severe.

Table 1.

Baseline data of the four groups

	Group 1(Emmetropia)	Group 2(Low to moderate myopia)	Group 3(High myopia)	p
Subjects (eye)	40	40	40	
Sex (M/F)	25/15	21/19	30/10	
Age (yr)	39.7 ± 8.1	40.0 ± 10.3	36.0 ± 12.3	0.14
Spherical equivalent (D)	−0.05 ± 0.55	−3.36 ± 1.51	−8.19 ± 1.99	0.000^*
BCVA^† (log MAR)	0.02 ± 0.05	0.03 ± 0.06	0.04 ± 0.05	0.3

Data are presented as mean ± SD.

^* Analysis of variance with Bonferroni correction. Significance differences were noted between group 1 and group 2 (p < 0.001) and group 2 ersus group 3 (p < 0.001)

^† BCVA = best corrected visual acuity.

Table 2.

Retinal thickness between RPE and IS/OS junction in photoreceptor layer (µm) in the 4 groups

	Group 1(Emmetropia)	Group 2(Low to moderate)	Group 3(High myopia)	p^*
Central fovea	62.00 ± 3.21 (p = 0.001)^†	60.03 ± 3.51 (p = 0.03)^‡	57.85 ± 4.45	0.001
1.0 mm superior^§	40.92 ± 6.80	39.23 ± 8.93	38.79 ± 8.05	0.84
1.0 mm inferior^§	41.42 ± 6.33	40.68 ± 6.8	39.24 ± 8.1	0.39
1.0 mm nasal^§	42.17 ± 5.72	40.88 ± 8.02	40.17 ± 10.3	0.33
1.0 mm temporal^§	42.10 ± 5.29	40.56 ± 8.13	38.57 ± 10.5	0.10
2.0 mm superior^∏	39.80 ± 6.80	38.23 ± 8.55	38.44 ± 7.63	0.40
2.0 mm inferior^∏	38.75 ± 7.96	39.05 ± 7.35	39.20 ± 7.19	0.87
2.0 mm nasal^∏	38.57 ± 5.45	39.91 ± 7.46	38.91 ± 7.46	0.78
2.0 mm temporal^∏	42.03 ± 7.09	41.24 ± 9.31	40.40 ± 10.65	0.29

Data are presented as mean ± SD.

^* One way analysis of variance

^† Statistically significant difference between group 1 and group 3 with Bonferroni post hoc test (p < 0.05)

^‡ Statistically significant difference between group 2 and group 3 with Bonferroni post hoc test (p < 0.05)

^§ Retinal thickness between RPE and IS/OS junction measured at the 1.0 mm superiorly, inferiorly, nasally and temporally from the fovea respectively (μ m)

^∏ Retinal thickness between RPE and IS/OS junction measured at the 2.0 mm superiorly, inferiorly, nasally and temporally from the fovea respectively (μ m).

Table 3.

Relationship between macular thickness (μ m) and myopia

	Group 1 (Emmetropia)	Group 2 (Low to moderate)	Group 3 (High myopia)	p^*
Average foveal (1.0 mm)	251.1 ± 14.6 (p = 0.001)^†	252.4 ± 18.8 (p = 0.001)^‡	269.1 ± 20.7	0.000
Superior inner	326.7 ± 12.8	324.9 ± 12.8	319.6 ± 16.2	0.07
Inferior inner	318.7 ± 11.1	320.8 ± 15.4	319.4 ± 17.5	0.82
Nasal inner	330.1 ± 12.6	325.1 ± 13.8	324.7 ± 17.3	0.19
Temporal inner	315.5 ± 12.5	314.7 ± 12.9	310.9 ± 16.3	0.30
Average inner	322.7 ± 10.8	321.4 ± 12.5	318.7 ± 15.6	0.37
Superior outer	282.8 ± 16.0 (p = 0.04)^†	281.6 ± 14.4 (p = 0.14)	274.6 ± 16.3	0.04
Inferior outer	275.3 ± 16.3 (p = 0.02)^†	270.2 ± 13.6 (p = 0.57)	265.7 ± 15.7	0.02
Nasal outer	303.6 ± 16.6	303.4 ± 23.3	296.8 ± 19.1	0.23
Temporal outer	269.9 ± 15.2 (p = 0.006)^†	266.3 ± 13.7 (p = 0.12)	259.3 ± 16.0	0.01
Average outer	282.9 ± 14.3 (p = 0.02)^†	280.4 ± 14.5 (p = 0.17)	274.1 ± 14.7	0.02
Overall average macula	284.3 ± 13.8	281.8 ± 13.9	279.15 ± 14.72	0.28
TMV (mm³)^§	10.3 ± 0.5 (p = 0.008)^†	10.2 ± 0.5 (p = 0.10)	9.9 ± 0.5	0.01

Data are presented as mean ± SD.

^* One way analysis of variance

^† Statistically significant difference between group 1 and group 3 with Bonferroni post hoc test (p < 0.05)

^‡ Statistically significant difference between group 2 and group 3 with Bonferroni post hoc test (p < 0.05)

^§ TMV = total macular volume.

Table 4.

Correlations between RPE-IS/OS junction thickness and refractive error

	r	p	r^*	p^*
Central fovea	0.40	0.001^†	0.42	0.001^†
1.0 mm superior^‡	0.03	0.85	0.10	0.71
1.0 mm inferior^‡	0.13	0.29	0.08	0.53
1.0 mm nasal^‡	0.16	0.10	0.13	0.28
1.0 mm temporal^‡	0.16	0.12	0.11	0.39
2.0 mm superior^§	0.07	0.57	0.1	0.44
2.0 mm inferior^§	0.15	0.34	0.08	0.53
2.0 mm nasal^§	0.06	0.58	0.05	0.87
2.0 mm temporal^§	0.12	0.25	0.09	0.49

^* Correlation coefficients of partial correlation analysis adjusted by age and gender

^† Significant at p-value < 0.05 by Pearson's correlation

^‡ Retinal thickness between RPE and IS/OS junction measured at the 1.0 mm superiorly, inferiorly, nasally and temporally from the fovea respectively (μ m)

^§ Retinal thickness between RPE and IS/OS junction measured at the 2.0 mm superiorly, inferiorly, nasally and temporally from the fovea respectively (μ m).

Table 5.

Correlations between macular measurements and refractive error

	r	p	r^*	p^*
Average foveal (1.0 mm)	−0.38	0.001^†	−0.40	0.001^†
Superior inner	0.18	0.08	0.17	0.09
Inferior inner	0.03	0.72	0.03	0.77
Nasal inner	0.15	0.11	0.15	0.11
Temporal inner	0.16	0.09	0.13	0.18
Average inner	0.16	0.09	0.14	0.12
Superior outer	0.23	0.01^†	0.22	0.01^†
Inferior outer	0.25	0.01^†	0.25	0.01^†
Nasal outer	0.15	0.09	0.14	0.12
Temporal outer	0.28	0.01^†	0.26	0.01^†
Average outer	0.25	0.01^†	0.24	0.01^†
Overall average macula	0.13	0.17	0.11	0.25
TMV (mm³)^‡	0.34	0.001^†	0.33	0.001^†

^* Correlation coefficients of partial correlation analysis adjusted by age and gender

^† Significant at p-value < 0.05 by Pearson's correlation

^‡ TMV = total macular volume.

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